Burlington, VT - Electronic Health Records Developer To Pay Second Largest Recovery In The History Of The District Of Vermont -- $57.25 Million -- To Settle False Claims Act Allegations

The Office of the United States Attorney for the District of Vermont stated today that Greenway Health, LLC (Greenway), a Tampa, Florida-based developer of electronic health records (EHR) software, will pay $57.25 million to resolve False Claims Act allegations that Greenway caused its users to submit false claims to the government by misrepresenting the capabilities of its EHR product “Prime Suite” and providing unlawful remuneration to users to induce them to recommend Prime Suite.

“In the last two years my office has resolved two matters against leading EHR developers where we alleged significant fraudulent conduct. These are the two largest recoveries in the history of this District and represent the return of over two-hundred and twelve million dollars of fraudulently obtained taxpayer monies. These cases are important, not only to prevent theft of taxpayer dollars, but to ensure that the promise of health technology is realized in the form of improved patient safety and efficient healthcare information flow,” said Christina E. Nolan, United States Attorney for the District of Vermont. “This resolution demonstrates my office’s initiative and resolve to vigorously uncover and to doggedly pursue these complex cases. We will be unflagging in our efforts to preserve the accuracy and reliability of Americans’ health records and guard the public fisc against corporate greed. EHR companies should consider themselves on notice.”

“Electronic health records are the central hub from which many health care decisions flow,” said Assistant Attorney General Joseph H. Hunt of the Justice Department’s Civil Division, “and both patients and providers rely on these technologies to safely and accurately record and transmit vital health information.” “This resolution demonstrates our continued commitment to uncovering misconduct in the EHR space, and our determination to promote public health while holding accountable those who seek to abuse the government’s trust.”

The American Recovery and Reinvestment Act of 2009 established the Medicare and Medicaid EHR Incentive Program to encourage healthcare providers to adopt and demonstrate their “meaningful use” of EHR technology. Under the program, the U.S. Department of Health and Human Services (HHS) made incentive payments available to eligible healthcare providers that adopt certified EHR technology and met certain requirements relating to their use of the technology. To obtain certification for their product, companies that develop and market EHR technology are required to demonstrate that their product(s) satisfies all applicable HHS-adopted certification criteria. Developers must first pass testing performed by an independent, accredited testing laboratory authorized by HHS, and then obtain and maintain certification by an independent, accredited certification body authorized by HHS.

In its complaint, the government contends that Greenway falsely obtained certification for its product Prime Suite when it concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification. Among other things, Greenway’s product did not fully incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions. Greenway accomplished its deception by preparing its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary.

Additionally, in order to be eligible to receive incentive payments, healthcare providers were required to meet certain targets for EHR-related activities. For example, at certain times providers were required to provide patients with clinical summaries following office visits. In its complaint, the government further alleges that Greenway was aware that an early version of Prime Suite did not correctly calculate the percentage of office visits for which its users distributed clinical summaries and thereby caused certain Prime Suite users to attest falsely that they were eligible for EHR incentive payments. Greenway refrained from rectifying this error in order to ensure that its users would continue to receive incentive payments. As a result, numerous users of this earlier version of Prime Suite falsely attested that they were eligible for EHR incentive payments when, in fact, they had not met all necessary use requirements.

Finally, the government alleged that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers.

“The False Claims Act settlement in this case will hopefully be a deterrent to those who selfishly circumvent our federal healthcare programs for their own benefit,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “The FBI will not tolerate companies stealing from federal taxpayers and the people who trust in the fairness of our federally funded healthcare programs.”

As part of the settlement, Greenway entered into a five-year Corporate Integrity Agreement (CIA) with the HHS Office of Inspector General (HHS-OIG) covering the company’s EHR software. This innovative five-year CIA requires, among other things, that Greenway retain an Independent Review Organization to assess Greenway’s software quality control and compliance systems and to review Greenway’s arrangements with health care providers to ensure compliance with the Anti-Kickback Statute. Greenway must provide prompt notice to its customers of any patient safety related issues and maintain on its customer portal a comprehensive list of such issues and any steps users should take to mitigate potential patient safety risks. The CIA also requires Greenway to allow Prime Suite customers to obtain the latest versions of Prime Suite at no additional charge, the opportunity to migrate their data from Prime Suite to another Greenway-developed software product also at no additional charge, and to give Prime Suite customers the option to have Greenway transfer their data to another EHR software vendor without penalties, service charges, or any other fees other than contractual amounts still owed in connection with goods or services already provided.

“Electronic Health Records can be key to an integrated health system providing improved care” said Derrick Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Putting patients at risk will result in intensive investigation and compliance obligations such as those in OIG’s comprehensive five-year Corporate Integrity Agreement.”

This matter was jointly handled by Assistant United States Attorneys Owen C.J. Foster and Nikolas P. Kerest, of the U.S. Attorney’s Office for the District of Vermont, Kelley Hauser and Edward Crooke of the Commercial Litigation Branch of the Civil Division, the Northern District of Georgia, the HHS Office of Inspector General, and multiple HHS agencies and components. Special Agents Gregory Peacock and Patrick Finno from the Federal Bureau of Investigation’s field office in Atlanta, Georgia provided significant investigative support to the investigation. Health Care Fraud Investigators George Thabault and Richard Lewis provided important investigative resources.